Methods:
Retrospective review of cases of corneal detergent capsule injuries from 2012-2013. Review of Material Data Safety Sheets (MSDS) of detergent capsule products available in the United States.

Results:
From July 2012 to August of 2013, six eyes of five patients with ocular surface injuries due to detergent capsules were reported. Of these cases, tear films of two eyes had an elevated pH at the time of injury. One case consisted of bilateral corneal injuries with associated unilateral conjunctival epithelial injury. The remaining four cases consisted of unilateral corneal epithelial injury; of these, a single case demonstrated significant chemical conjunctivitis and progression of corneal epithelial loss requiring amniotic membrane application. Topical antibiotic or combination steroid/antibiotic ointment was successfully used to manage the nonsurgical cases after initial saline irrigation and pH normalization. Median time to re-epithelialization was 8 days (range 2-16 days). Review of MSDS for detergent capsules in the US reveals a majority of products do not report a significant alkaline pH of packaged detergent.

Conclusions:
Highly concentrated detergent capsules pose a particular risk of ocular surface injury to pediatric patients. Delayed healing of ocular surface epithelium can be observed in these injuries. With the recent advent of super-concentrated detergent capsules available in the US market place, responsible labeling and packaging should be utilized to prevent injuries. The mechanism of injury in these patients seems to be more complex than simple alkaline injury as has been presumed. Amniotic membrane application may be a useful intervention in severe cases.